Systematic literature review: quality of life associated with insulin pump use in type 1 diabetes

WSTĘP. W niniejszej pracy przedstawiono systematyczny przegląd opublikowanej literatury w celu odpowiedzi na pytanie, czy ciągły podskórny wlew insuliny (CSII) poprawia jakość życia chorych na cukrzycę typu 1. MATERIAŁ I METODY. Przeszukano elektroniczne bazy danych oraz opublikowane wyniki badań, a po konsultacji z dwiema grupami ekspertów wybrano istotne prace, które opublikowano do lipca 2005 roku. Aby zidentyfikować doniesienia spełniające wybrane kryteria selekcji, zastosowano wieloetapowy proces wyboru, a następnie poddawano prace krytycznej ocenie. WYNIKI. Po analizie tytułów i streszczeń do dalszego etapu wybrano 84 potencjalnie odpowiednie prace opublikowane w wymienionym przedziale czasowym. Z tych doniesień wyodrębniono 28 pełnych artykułów, z których 17 spełniało kryteria włączenia do analizy. Z istniejących danych piśmiennictwa wynikają rozbieżne wnioski. Spośród 5 randomizowanych, kontrolowanych badań poddanych analizie z 3 wynikały niejednoznaczne wnioski, w 1 wskazywano na poprawę jakości życia, a w 1 nie dowiedziono korzyści dotyczących jakości życia. WNIOSKI. Wyniki badań przedstawiają sprzeczne wnioski dotyczące poprawy jakości życia chorych na cukrzycę typu 1 stosujących terapię CSII. Istniejące prace mają wady powodujące, że wnioskowanie co do jakości życia pacjentów stosujących terapię pompą insulinową jest trudne. Brakuje przekonujących dowodów, że korzyści ze stosowania CSII nie istnieją lub inaczej - niewłaściwa metodologia i niespójna analiza dotycząca jakości życia utrudniają ocenę tego zagadnienia. Brak udowodnionego korzystnego wpływu na jakość życia prawdopodobnie wiąże się z przedstawionymi uchybieniami w badaniach, a nie z faktem, że terapia polegająca na zastosowaniu pomp insulinowych nie koreluje z poprawą jakości życia chorych.AIM. To review systematically the published literature addressing whether continuous subcutaneous insulin infusion (CSII) provides any quality of life benefits to people with type 1 diabetes. METHODS. Electronic databases and published references were searched and a consultation with two professional groups was undertaken to identify re levant studies published up to July 2005. A multistep selection process was then undertaken to identify those articles which met the specific selection criteria, which were then critically reviewed. RESULTS. Eighty-four potential relevant articles were identified from examination of titles and abstracts published during the specified time frame. Of these, 28 articles were retrieved in full text, of which 17 fulfilled the specific criteria for inclusion. Mixed results emerged from existing literature. Of the five randomized controlled trials, three reported mixed results, with one study reporting quality of life benefits and one reporting no evidence of quality of life benefits. CONCLUSIONS. There is conflicting evidence reported in the various studies on the quality of life benefits of CSII in type 1 diabetes. Existing research is flawed, making a judgement about the quality of life benefits of insulin pump use difficult. There is no strong evidence against quality of life benefits associated with CSII or otherwise, with poor methodology and inconsistent assessment of quality of life clouding the issue. The lack of reported benefit is probably a function of this rather than pump therapy not offering any quality of life benefits

Low-temperature electron dephasing time in AuPd revisited

Ever since the first discoveries of the quantum-interference transport in mesoscopic systems, the electron dephasing times, $\tau_\phi$, in the concentrated AuPd alloys have been extensively measured. The samples were made from different sources with different compositions, prepared by different deposition methods, and various geometries (1D narrow wires, 2D thin films, and 3D thickfilms) were studied. Surprisingly, the low-temperature behavior of $\tau_\phi$ inferred by different groups over two decades reveals a systematic correlation with the level of disorder of the sample. At low temperatures, where $\tau_\phi$ is (nearly) independent of temperature, a scaling $\tau_\phi^{\rm max} \propto D^{-\alpha}$ is found, where $tau_\phi^{\rm max}$ is the maximum value of $\tau_\phi$ measured in the experiment, $D$ is the electron diffusion constant, and the exponent $\alpha$ is close to or slightly larger than 1. We address this nontrivial scaling behavior and suggest that the most possible origin for this unusual dephasing is due to dynamical structure defects, while other theoretical explanations may not be totally ruled out.Comment: to appear in Physica E, Proceedings for the International Seminar and Workshop "Quantum Coherence, Noise, and Decoherence in Nanostructures", 15-26 May 2006, Dresde

Horizontal Branch Stars: The Interplay between Observations and Theory, and Insights into the Formation of the Galaxy

We review HB stars in a broad astrophysical context, including both variable and non-variable stars. A reassessment of the Oosterhoff dichotomy is presented, which provides unprecedented detail regarding its origin and systematics. We show that the Oosterhoff dichotomy and the distribution of globular clusters (GCs) in the HB morphology-metallicity plane both exclude, with high statistical significance, the possibility that the Galactic halo may have formed from the accretion of dwarf galaxies resembling present-day Milky Way satellites such as Fornax, Sagittarius, and the LMC. A rediscussion of the second-parameter problem is presented. A technique is proposed to estimate the HB types of extragalactic GCs on the basis of integrated far-UV photometry. The relationship between the absolute V magnitude of the HB at the RR Lyrae level and metallicity, as obtained on the basis of trigonometric parallax measurements for the star RR Lyrae, is also revisited, giving a distance modulus to the LMC of (m-M)_0 = 18.44+/-0.11. RR Lyrae period change rates are studied. Finally, the conductive opacities used in evolutionary calculations of low-mass stars are investigated. [ABRIDGED]Comment: 56 pages, 22 figures. Invited review, to appear in Astrophysics and Space Scienc

History of clinical transplantation

How transplantation came to be a clinical discipline can be pieced together by perusing two volumes of reminiscences collected by Paul I. Terasaki in 1991-1992 from many of the persons who were directly involved. One volume was devoted to the discovery of the major histocompatibility complex (MHC), with particular reference to the human leukocyte antigens (HLAs) that are widely used today for tissue matching.1 The other focused on milestones in the development of clinical transplantation.2 All the contributions described in both volumes can be traced back in one way or other to the demonstration in the mid-1940s by Peter Brian Medawar that the rejection of allografts is an immunological phenomenon.3,4 © 2008 Springer New York

On the mechanisms governing gas penetration into a tokamak plasma during a massive gas injection

A new 1D radial fluid code, IMAGINE, is used to simulate the penetration of gas into a tokamak plasma during a massive gas injection (MGI). The main result is that the gas is in general strongly braked as it reaches the plasma, due to mechanisms related to charge exchange and (to a smaller extent) recombination. As a result, only a fraction of the gas penetrates into the plasma. Also, a shock wave is created in the gas which propagates away from the plasma, braking and compressing the incoming gas. Simulation results are quantitatively consistent, at least in terms of orders of magnitude, with experimental data for a D 2 MGI into a JET Ohmic plasma. Simulations of MGI into the background plasma surrounding a runaway electron beam show that if the background electron density is too high, the gas may not penetrate, suggesting a possible explanation for the recent results of Reux et al in JET (2015 Nucl. Fusion 55 093013)

Velocity-space sensitivity of the time-of-flight neutron spectrometer at JET

The velocity-space sensitivities of fast-ion diagnostics are often described by so-called weight functions. Recently, we formulated weight functions showing the velocity-space sensitivity of the often dominant beam-target part of neutron energy spectra. These weight functions for neutron emission spectrometry (NES) are independent of the particular NES diagnostic. Here we apply these NES weight functions to the time-of-flight spectrometer TOFOR at JET. By taking the instrumental response function of TOFOR into account, we calculate time-of-flight NES weight functions that enable us to directly determine the velocity-space sensitivity of a given part of a measured time-of-flight spectrum from TOFOR

Relationship of edge localized mode burst times with divertor flux loop signal phase in JET

A phase relationship is identified between sequential edge localized modes (ELMs) occurrence times in a set of H-mode tokamak plasmas to the voltage measured in full flux azimuthal loops in the divertor region. We focus on plasmas in the Joint European Torus where a steady H-mode is sustained over several seconds, during which ELMs are observed in the Be II emission at the divertor. The ELMs analysed arise from intrinsic ELMing, in that there is no deliberate intent to control the ELMing process by external means. We use ELM timings derived from the Be II signal to perform direct time domain analysis of the full flux loop VLD2 and VLD3 signals, which provide a high cadence global measurement proportional to the voltage induced by changes in poloidal magnetic flux. Specifically, we examine how the time interval between pairs of successive ELMs is linked to the time-evolving phase of the full flux loop signals. Each ELM produces a clear early pulse in the full flux loop signals, whose peak time is used to condition our analysis. The arrival time of the following ELM, relative to this pulse, is found to fall into one of two categories: (i) prompt ELMs, which are directly paced by the initial response seen in the flux loop signals; and (ii) all other ELMs, which occur after the initial response of the full flux loop signals has decayed in amplitude. The times at which ELMs in category (ii) occur, relative to the first ELM of the pair, are clustered at times when the instantaneous phase of the full flux loop signal is close to its value at the time of the first ELM

The prevalence of co-morbid depression in adults with Type 1 diabetes: systematic literature review.

Aim To review the literature estimating the cross-sectional prevalence of clinical depression in adults with Type 1 diabetes.Methods Electronic databases and published references were used to identify studies published between January 2000 and June 2004, with a previous meta-analysis used to identify studies before 1 January 2000.Results Between January 2000 and June 2004, a further five eligible studies were identified. Only one was a controlled study using diagnostic interviewing to determine rates of depression. Taking all of the eligible studies identified by the previous meta-analysis and this search, the prevalence of clinical depression in controlled studies was 12.0% for people with diabetes compared with 3.2% for control subjects. In studies with no control group, the prevalence of clinical depression was 13.4%.Conclusion There are wide-ranging differences reported in the various studies on the prevalence of depression in Type 1 diabetes. In view of the differing methods of diagnosis and small participant numbers, the results should be viewed with caution. A controlled study using diagnostic interviewing techniques to determine levels of depression is recommended to provide a clearer picture of both the prevalence and characteristics of that depression

Effectiveness of a computerised assessment tool to prompt individuals with diabetes to be more active in consultations

The objective of this study was to assess whether using a computerised touch screen assessment tool prior to outpatient consultation makes patients more active in the consultation. In a non-randomised control group design, immediately after consultations, which were recorded, patients and professionals completed a consultation review sheet and the Health Care Climate Questionnaire (HCCQ). Views about the assessment were then elicited. Intervention participants completed the Accu-Chek Interview (a computerised psychosocial assessment) prior to the consultation. After completing the Accu-Chek Interview, participants were more active in the consultation asking twice as many questions (t = 3.167; df = 67.07; p = 0.002), without lengthening the consultations. There was no significant difference in the duration of consultations (t = -1.20; df = 129; p = 0.234). Patients valued completing the interview: it does prompt you to ask questions that you may not think of at the time. The demographics were similar for both groups and there was no effect on the HCCQs. It was concluded that the Accu-Chek Interview seems to activate patients into asking more questions (a marker for better bio-medical outcomes in a recent meta-analysis) and is valued by patients to help improve diabetes care. The Accu-Chek Interview could be routinely offered to outpatients attending diabetes centres as a tool to improve communication, increase autonomy and potentially improve outcomes. Copyright © 2007 John Wiley & Sons